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Monday, November 12, 2007
Overweight men with prostate cancer have a higher risk of dying
Men who are overweight when they have locally advanced prostate cancer have almost double the risk of dying from the disease compared with men of normal weight, new research says.
The study, led by a team at Massachusetts General Hospital, is the first to find that excess weight alone is associated with deaths in men whose tumors had grown beyond the prostate or spread to lymph nodes, according to the study, which appears in the journal Cancer.
"The prevalence of overweight and obesity continues to increase in United States, so it’s an issue that's perhaps more important than ever," author Dr. Matthew R. Smith said in an interview. "What we need to do from here are additional studies to understand the mechanisms by which overweight and obesity are associated with worse prostate cancer mortality."
For men with a normal body mass index of 25, the death rate from prostate cancer was 6.5 percent after eight years. For overweight men, with a BMI between 25 and 30, it was 13.1 percent, and for obese men, with a BMI over 30, the death rate was 12.2 percent.
Obesity is not a new suspect in prostate cancer. Previous work has linked being overweight to having more aggressive forms of the cancer and higher rates of recurrence after radiation and surgery to remove the prostate gland. But other potential reasons for the difference in outcomes, from difficulty examining obese patients to possible biases in screenings, had not been isolated in the observational studies.
The study reported in Cancer analyzed data from a large randomized trial originally conducted to study radiation and hormone therapy in about 900 men with prostate cancer. That means the men had similar disease characteristics to be included in the trial. The authors, who also include researchers from Fox Chase Cancer Center and UCLA, looked at the men's BMI at the start of the trial and what happened to them over about eight years of follow-up.
Dr. Oliver Sartor of Dana-Farber Cancer Institute said the researchers have made an important observation from a well-designed trial.
"Now the hypothesis-driven question to ask is whether or not weight loss after diagnosis with prostate cancer will lead to better outcomes," he said in an interview. "That's an important question."
Tuesday, November 6, 2007
Two Brigham surgeons top list of device maker payments
By Elizabeth Cooney, Globe Correspondent
Two Boston orthopedic surgeons each received $6.75 million this year from a maker of joint replacement implants, the largest among hundreds of payments revealed in a $311 million settlement of a federal criminal case that alleged five companies paid doctors to use their products.
Dr. Richard Scott and Dr. Thomas Thornhill of Brigham and Women's Hospital were paid royalties and consulting fees this year by the Johnson & Johnson subsidiary DePuy Orthopaedics, according to documents made public by the company last week. DePuy makes implants used in hip and knee replacements.
Four other companies -- Zimmer Inc., Biomet Orthopedics Inc., Smith & Nephew Inc. and Stryker Orthopaedics -- were also part of an agreement with the US Department of Justice. The five companies, which together share 95 percent of the market for hip and knee implants, were being investigated for using consulting agreements with orthopedic surgeons to influence their choice of implants. Making payments was a common practice from 2002 through 2006, according to the US Attorney's Office in New Jersey.
The disclosures come as payments to doctors by device and drug companies come under increasing scrutiny because of concerns they create a financial conflict for physicians. But the industry, and many doctors and hospitals, defend the practice, saying it fosters innovation and properly rewards physicians for helping to develop new treatments.
Without admitting fault, the device companies agreed to make public their lists of payments for this year. Michael Drewniak, a spokesman for the US Attorney's Office, said in an interview yesterday that this year's payments were similar to amounts in previous years his office examined. More than 40 surgeons were paid $1 million or more this year, the lists showed.
Scott and Thornhill said in a statement supplied by Brigham and Women's that the royalties come from their design of a knee replacement implant licensed to J&J in 1986 and a hip replacement implant licensed in 1991. They said they donate their fees from consulting to charity.
"We are both very proud of the work we have done over the years to advance the mission of orthopedic medicine," their statement said.
Scott and Thornhill do not receive royalties when they or any other surgeons use their implants at the Brigham, they said. They did not break down the amounts of royalties and fees, nor were they available to comment beyond their statement.
DePuy, which will pay a fine of $84.7 million, issued a statement last week saying, "The surgeons who received the most significant compensation from DePuy Orthopaedics contributed intellectual property and ongoing expertise to the development of products."
Zimmer listed 15 Massachusetts General Hospital surgeons who received payments totaling $8.7 million this year. The hospital said in a statement that the money represents royalties for developing materials in the 1990s that are used in implants, and that the money goes to the hospital. Mass. General does not get royalties for implants that its surgeons use at the hospital.
"Ongoing research in orthopaedic surgery has led to enhancements in strength and durability of the materials, and the MGH continues to work with industry, including Zimmer and Biomet, to license and patent innovations that will benefit patients now and in the future," the hospital statement said.
Criminal complaints were filed against four of the five implant makers, charging them with conspiring to violate the federal anti-kickback statute, the US Attorney's office said, but the complaints will be dismissed if the companies comply with terms that include federal monitoring for 18 months and five-year corporate integrity agreements. Stryker cooperated with the investigation before the other companies and has entered a non-prosecution agreement with the government.
Friday, November 2, 2007
Compassionate caregiver connects with patients and families
Barbara Moscowitz (left) thinks older adults are overlooked by people who can't see past their walkers and hearing aids, their illnesses and infirmities, to the human beings inside.
"I want to live in a universe that will see me not as a long list of chronic diseases but as an individual first who might have to cope with illness," Moscowitz, 54, said in an interview.
For her work at Massachusetts General Hospital with people with Alzheimer's and their families, she received the Kenneth B. Schwartz Center's Compassionate Caregiver of the Year Award last night at a dinner attended by 1,700 people. The honor is named for the Boston lawyer who, while being treated for the lung cancer he would die of, wrote movingly in the Boston Globe magazine about how his caregivers' human touch "made the unbearable bearable."
Coordinator of geriatric social work at Mass. General, Moscowitz focuses on the needs of families confronting their loved ones' diagnosis with Alzheimer's disease.
"So many families of Alzheimer's patients need so much support and guidance. It's like learning a new language," she said. "It just disturbs me greatly that a lot of people are given a diagnosis and then a web site or telephone number and told to go off and figure it out."
Moscowitz gave unwavering assistance to Kasey Kaufman when her mother was slipping away into the fog of dementia, the former CBS4 reporter said in a letter nominating Moscowitz for the Schwartz award.
"I like to say that Barbara saved our lives but that would be telling only part of the story," she wrote. "Barbara helped us to understand my mom's illness."
Kaufman's mother called Moscowitz "that tiny gal with the big heart," Kaufman's letter said.
Patricia Bresky, a psychologist in California, said in her first phone conversation with Moscowitz, she grasped not only her father's medical condition but also the family dynamics.
"For the first time since the onset of my father's symptoms two years before, I felt the ground beneath me," Bresky said in a letter to the Schwartz Center.
Moscowitz said she values the Schwartz Center's work to keep human connections alive in healthcare that can be hurried.
"They are the penicillin for what ails medicine now," she said.
Tuesday, October 30, 2007
Specialist referrals for imaging vary with who does the test, Mass. General study says
Doctors who send their patients for imaging tests to someone in their own specialty order diagnostic imaging more frequently than doctors who refer their patients to radiologists, Boston researchers report.
The reason for the difference may be financial, radiologist Dr. G. Scott Gazelle of Massachusetts General Hospital said in an interview about his article in the November issue of Radiology.
But that's impossible to know from the study's results, Dr. Nicholas DiNubile, a spokesman for the American Academy of Orthopedic Surgeons, responded in an interview, saying numbers of MRIs, CT scans, and X-rays alone can't determine whether they are ordered too often or not enough.
Looking at a national database of outpatient visits for such conditions as heart problems, broken bones, joint pain or suspected stroke, Gazelle and his team from the Institute for Technology Assessment at Mass. General found that physicians ordered imaging tests up to twice as often if they referred patients to doctors in their own specialty such as cardiology, orthopedics or neurology, compared with doctors who sent their patients to radiologists.
Previous research has indicated that doctors may order more scans when referring patients to a facility they own, but the authors of the new study decided to look at same-specialty referrals overall, rather than only referrals doctors made to imaging facilities they own. Gazelle said the authors made that choice in light of laws intended to curb self-referral that restrict some Medicare payments to doctors who refer patients to themselves.
"People are much more clever about it now," said Gazelle, who is on the board of chancellors of the American College of Radiology. "Same-specialty referral is in my view a proxy for self-referral."
All imaging has grown rapidly over recent years, but imaging done by non-radiologists has grown faster than imaging by radiologists, the study notes.
"I don't have a problem if a cardiologist or an orthopedist interprets imaging studies if they are qualified and do a good job," Gazelle said. "I do have a problem with the financial motivation to overuse it."
DiNubile, a knee specialist in Havertown, Penn., whose 25-surgeon group has its own imaging center staffed by a radiologist, said there is a turf war between specialists and radiologists who want to get back their business. He faults the study for not saying who owned the imaging facility where patients are being sent.
"The real question is whether that increases referrals when the physician owns his own shop," he said.
A better way to evaluate utilization rates would be to examine the imaging tests themselves to see if they were ordered appropriately, DiNubile said. Too many normal readings would suggest that too many tests are being ordered, for example.
"You always want to be sure to do the right thing," DiNubile said. "Is the right thing more utilization or less?"
Gazelle said the study was not intended to measure the quality of the imaging tests.
"The issue is we are using societal resources to pay for healthcare," he said. "We all ought to be ordering studies for the same reason."
Scientists rate Mass. General best place to work
Massachusetts General Hospital is the best place to work in academia, according to a survey of scientists by The Scientist. Beth Israel Deaconess Medical Center ranked 10th and Dana-Farber Cancer Institute came in 34th in the magazine's list of top 40 US academic institutions.
The poll asked respondents to rate their working environment. Mass. General scored high in job satisfaction, peers, management and policies, and infrastructure and environment, the magazine reports in its November issue, which will go online tomorrow.
The Top 15 institutions in the U.S.:
1. Massachusetts General Hospital, Boston, MA
Wednesday, October 24, 2007
Boston group to share genetic data on autism
A Boston group is sharing genetic information from families affected by autism with other researchers to promote understanding of the developmental disorder.
The Autism Consortium, whose members include hospitals, medical schools and universities in the Boston area, will transfer profiles of 500,000 genetic variations found across the genomes of 700 families with two or more children who have autism. The data will be held by the Autism Genetic Resource Exchange, a program of the advocacy organization Autism Speaks. Scientists can apply to the exchange, which gathered DNA from the families. The samples have been scanned for sequences where there are deletions or extra copies of DNA segments. The consortium is sharing the genetic variations it found.
"We returned all of the raw data to AGRE so they can distribute it to any other investigtors who want to begin exploring what may be the genetic underpinnings of autism," Mark Daly, a consortium member from Massachusetts General Hospital and the Broad Institute of MIT and Harvard, said in an interview. "Understanding the genetics underlying a complex disease is not an easy problem to solve. So there's no excuse for hoarding your data when much more can be learned by sharing."
Only a small percentage of autism arises from a recognizable genetic cause, such as Fragile X syndrome, Daly said. Recent research suggests that some families with autism might have higher rates of genomic abnormalities, but very few of these abnormalities have been conclusively identified.
"There's very strong heritability to autism but very little of the heritability has been explained by specific mutations of specific genes," he said. "What we hope is that this data is a starting point. We need to perform collaborative research in the spirit of the Human Genome Project to deliver on the trust the public has placed in us."
Members of the Autism Consortium are Beth Israel Deaconess Medical Center, Boston Medical Center, Boston University, Boston University School of Medicine, the Broad Institute of MIT and Harvard, Cambridge Health Alliance, Children’s Hospital Boston, Harvard University, Harvard Medical School, Massachusetts General Hospital, Massachusetts Institute of Technology, McLean Hospital and Tufts-New England Medical Center.
MGH to study fish oil compounds as treatment for depression
Two compounds in fish oil will be tested as treatments for depression by researchers in Boston and Los Angeles.
Massachusetts General Hospital in Boston and Cedars-Sinai Medical Center in Los Angeles are recruiting volunteers for a randomized clinical trial that will compare two omega-3 fatty acids, DHA and EPA, against each other and against inactive pills in 300 adults who have major depression, the hospitals said. To be eligible, participants must not be taking anti-depressant medications, principal investigator Dr. David Mischoulon of Mass. General said in an e-mail interview.
Previous studies have suggested that the fatty acids, which are found in salmon, mackerel and tuna, might help reverse depression by affecting brain processes involved in regulating mood. The compounds have not been systematically tested before.
In this five-year trial, participants and researchers will not know who is taking an omega-3 supplement and who is not. People will be enrolled in the trial for eight weeks, after which they will be eligible for three months of free follow-up care from a physician in the study.
To learn more about the study, which is funded by the National Institutes of Health, call Mass. General’s Depression Clinical and Research Program at (877) 552-5837 or Cedars-Sinai at (888) 233-2773.
Monday, October 22, 2007
David H. Koch, an MIT alum and prostate cancer survivor who earlier this month pledged $100 million to build a new cancer research center at MIT, will donate $5 million to the Prostate Cancer Foundation for an initiative using nanotechnology. Four research institutions will collaborate on ways to use the technique, in which tiny particles are designed to attack tumors but spare normal cells, according to the foundation. Dr. Omid Farokhzad of Brigham and Women's Hospital is the principal investigator, Robert Langer of MIT will lead engineering and manufacturing for the project, Dr. Philip Kantoff of the Dana-Farber/Harvard Cancer Center Prostate Cancer Program will head clinical research, and Dr. Neil Bander, an antibody expert, will direct a group from the Weill Cornell Medical College.
Dr. Jonathan Winickoff of the MassGeneral Hospital for Children has won a $4 million grant from the National Institutes of Health to conduct a trial to help protect children from second-hand smoke by encouraging their parents to quit smoking. The study is based on a pilot program that targeted parents in their children's pediatrician's office. Fifty pediatric practices are being recruited through the American Academy of Pediatrics' Pediatric Research in Office Settings network.
Dr. Jeffrey Flier, dean of Harvard Medical School, and Lita Nelsen, director of MIT's Technology Licensing Office, have been named 2007 Biomedical Research Leaders by the Massachusetts Society for Medical Research. Flier was honored for his commitment to diabetes and obesity research and medical education, according to the nonprofit society, whose members include universities, hospitals, research institutes, and biotech and pharmaceutical companies. Nelsen was recognized for managing 500 new inventions per year from MIT, the Whitehead Institute and Lincoln Laboratory.
Dr. Joseph Vacanti, chief of surgery at the MassGeneral Hospital for Children, has won the 2007 John Scott Award for his work in tissue engineering. Since 1834, the awards, administered by a board acting for the city of Philadelphia, have recognized inventions that contribute to mankind's "comfort, welfare and happiness," according to the board. Vacanti's work combines engineering and biology to develop substitutes to help tissue or organs function. He shares this year's prize with Dr. Albert J. Stunkard of the University of Pennsylvania School of Medicine, who is being honored for his work to understand and treat eating disorders.
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Tuesday, October 16, 2007
Ties between industry and medical schools widespread, survey finds
Almost two-thirds of the people leading medical school departments have personal relationships with industry and two-thirds of these departments have similar ties, a survey of 140 medical schools and top-funded teaching hospitals found. Most of the doctors polled said their relationships had no effect on their decisions, but they thought multiple conflicts of others could lead to biased research.
"When you say 'everyone's doing it,' the accumulation of data suggests that's really true," Eric G. Campbell, associate professor of health policy at the Massachusetts General Hospital Institute for Health Policy, said in an interview. He is the lead author of the study appearing in tomorrow's Journal of the American Medical Association. "There is virtually no aspect of medical education in which drug companies don't have significant relationships."
Campbell said the study gives the first portrayal of the links between companies and medical schools on the department level. The authors sampled departments of medicine, psychiatry, microbiology and one other nonclinical department at each surveyed institution.
They asked the individual chairs if they had served on company boards or speakers bureaus, been a paid consultant, or received compensation in the form of stock options, travel subsidies or honoraria. For departments, the questions were whether they got unrestricted funds, support for graduate students, or money for holding research seminars. They were asked if discretionary funds from industry paid for food and beverage, travel to meetings, journal subscriptions, software, or research or clinical equipment.
When asked about other chairs' involvement with companies, almost three-quarters of the respondents thought having more than one substantial role, such as being a consultant and a board member, would harm the department's ability to conduct independent research.
"Failure to address the existence and influence of industry relationships with academic institutions could endanger the trust of the public in US medical schools and teaching hospitals," the authors concluded.
Thursday, October 11, 2007
Four Boston doctors named Howard Hughes investigators
Four Boston physician-scientists have been selected by the Howard Hughes Medical Institute in an initiative to promote patient-oriented research.
Dr. George Daley and Dr. Elizabeth Engle, both of Children’s Hospital Boston, Dr. Daniel Haber of Massachusetts General Hospital, and Dr. S. Ananth Karumanchi of Beth Israel Deaconess Medical Center are among 15 new HHMI Investigators. Boston has the most winners in this new group.
Daley is a world leader in hematopoetic and embryonic stem cell research; Engle has identified genetic factors behind disorders that limit patients’ control over their eye movements; Haber studies how individuals’ genetic mutations affect their response to cancer drugs; and Karumanchi has identified the soluble proteins produced by the placenta that can trigger pre-eclampsia in a pregnant mother.
HHMI received 242 applications from eligible candidates. The 15 selected physician-scientists from 13 institutions will receive a total
of about $150 million in their first five-year terms.
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Tuesday, October 9, 2007
Breast-feeding medical student to take licensing test tomorrow
By Elizabeth Cooney, Globe Correspondent
A Harvard medical student who went to court to get extra time to pump breast milk during a licensing exam will start taking the test tomorrow.
Sophie Currier, who is breast-feeding her 5-month-old daughter, sued the National Board of Medical Examiners on Sept. 5 when it refused to give her more than the usual 45-minute break allowed to students taking the nine-hour exam. Since then the case has gone through seven rulings.
Today the Supreme Judicial Court denied a request from the board for an expedited review of the case after a state Appeals Court ruling on Friday cleared the way for Currier to have the extra time. The examination board had also asked for a single justice to hear an appeal, but the court did not rule on that petition, board spokeswoman Carol Thomson said in an interview.
"Sophie Currier is scheduled to take the test tomorrow and the following day," Thomson said. "The board certainly will comply with the court's requirements and she will take the test with extra time."
Currier, who must pass the test before beginning her residency at Massachusetts General Hospital, has been granted permission to take the test over two days because of her dyslexia and attention deficit hyperactivity disorder. She will get an hour of extra break time each day.
The 33-year-old Brookline resident had argued that it would be uncomfortable and possibly harmful to her health if she could pump breast milk only during standard breaks.
Currier was unavailable to comment today, her spokeswoman Alex Zaroulis said.
"Sophie is looking forward to taking the test tomorrow. She's focused, she's prepared," Zaroulis said. "This has all been about Sophie being able to take this test and be able to express milk while she takes the test in a humane and sanitary way."
One of her lawyers said she found it troubling that the organization responsible for licensing doctors continues to take such an "anti-female approach."
"We took this case pro bono because we believed strongly in the legal positions that were set forth regarding a nursing mother's right in the workplace and by extension, a nursing mother's right to be able to become a doctor and take the medical exam without being at risk for physical harm," said Lauren Stiller Rikleen, who worked on the case with Christine Smith Collins of the law firm Bowditch & Dewey.
Monday, October 8, 2007
Five Boston researchers named to Institute of Medicine
Five Boston researchers have been elected to membership in the Institute of Medicine, a prestigious group established by the National Academies of Science to analyze health issues and make recommendations on policy.
Among the 65 new US members, five are from Massachusetts (four from Harvard, one from MIT), three are from Connecticut (all from Yale) and one is from New Hampshire (Dartmouth). The current 1,538 active members chose new members from candidates nominated for achievement and commitment to service, the IOM said in its announcement of new members today.
The Massachusetts members are:
Dr. Emery N. Brown, professor of anesthesia, department of anesthesia and critical care, Massachusetts General Hospital; and professor of computational neuroscience, health sciences, and technology, Massachusetts Institute of Technology
Dr. William G. Kaelin Jr., investigator, Howard Hughes Medical Institute, and professor, Harvard Medical School, Dana-Farber Cancer Institute
Dr. David T. Scadden, professor of medicine and co-chair, department of stem cell and regenerative biology, and co-director, Harvard Stem Cell Institute; and director, Center for Regenerative Medicine, Massachusetts General Hospital
Jonathan G. Seidman, professor of genetics, Harvard Medical School
B. Katherine Swartz, professor of health economics and policy, department of health policy and management, Harvard School of Public Health
The three new members from Connecticut are:
Dr. Robert J. Alpern, dean, Yale University School of Medicine
Dr. Harlan M. Krumholz, professor of medicine and epidemiology and public health, and professor of internal medicine, Yale University School of Medicine
Dr. Mary E. Tinetti, professor of medicine, epidemiology and public health, and director, Yale Program on Aging, Yale University School of Medicine
New Hampshire has one new member:
Jonathan S. Skinner, professor of economics, Dartmouth College, and professor of community and family medicine, Dartmouth Medical School
Wednesday, October 3, 2007
New anesthesia method blocks pain without numbness or paralysis
By Colin Nickerson, Globe Staff
The world's hottest work in anesthesiology is being done at Harvard, where researchers are pouring pepper on pain.
Scientists at Harvard Medical School and Massachusetts General Hospital today described a new "targeted" approach to anesthesia that uses the active ingredient in chili peppers as part of an ingenious recipe for blocking pain neurons. Most critically, the technique doesn't cause the numbness or partial paralysis that is the unwelcome side effect of anesthesia used for surgery performed on conscious patients.
If approved for use in humans, the method could dramatically ease the trial of giving birth -- by sparing women pain while allowing them to physically participate in labor. It could also diminish the trauma of knee surgery, for instance, or the discomfort of getting one's molars drilled. Not only would there be no "ouch," there would be none of the sickening wooziness or loss of motor control that comes from standard forms of "local" anesthesia.
In time, the process might even be employed for major surgery on the heart and other organs, the researchers said. More prosaically, the work might also represent a breakthrough cure for the common itch.
The work on lab rats, described in the scientific journal Nature, breaks from the standard approach to local anesthesia, which usually involves anesthetics delivered by catheter tubes or injections that silence all neurons in a given region of the body, not just those that sense pain. Shutting down just the pain neurons means that patients could still feel a light touch and other non-hurtful sensations.
"This could really change the experience of, for example, knee surgery, tooth extractions, or childbirth," said Dr. Clifford Woolf, senior author of the study and a researcher in anesthesia and pain management at Mass. General. "The possibilities are almost endless."
Woolf collaborated with Bruce Bean, professor of neurobiology at Harvard Medical School, in research that employed surprisingly basic scientific principles as well as some unlikely ingredients -- capsaicin, the stuff that imparts "hot" to chili peppers, as well as an all-but-forgotten variation of a standard anesthesia, long dismissed as clinically useless.
"We plucked a little of this and little of that off the shelves," Bean said. "The project is really a great illustration of how basic biological principles can have very practical applications."
Indeed, scientists with no involvement in the Harvard study were most surprised by its simplicity.
"It's a really clever piece of work, based on one of those 'I wish I'd thought of that' ideas," said Dr. Stephen G. Waxman, head of the department of neurology at Yale University's School of Medicine. "This is an important piece of research."
There's also sweet historic symmetry to the discovery.
Boston, after all, is the city that invented feeling no pain -- at least in surgery.
Modern anesthesia was first successfully employed in surgery in October 1846, one of the greatest moments in medicine. In Boston's Public Garden, the second-largest statue -- after that of George Washington on his horse -- is a soaring pillar, adorned with roaring lions and bas-relief depictions of 19th Century surgeons, that celebrates the "discovery that the inhaling of ether causes insensibility to pain. First proved to the world at the Massachusetts General Hospital."
Not far away, modern Mass. General's original "ether dome" still stands, a national landmark and popular pilgrimage point for anesthesiologists from around the world.
The work undertaken by Woolf, Bean and post-doctoral researcher Alexander Binshtok exploits well-known concepts of how electrical signals in the nervous system depend on ion channels -- proteins that make passageways through the membranes of nerve cells. Pain-sensing neurons possess a unique channel protein, TRPV1, but one that is usually blocked by a molecular "gate."
Medicine for more than 150 years has relied on general and standard anesthetics that penetrate and suppress sensation in all neurons, not just those nerve cells dedicated to sensing pain. That's why an epidural or a simple shot of Novocain leaves a whole region of the body numb or paralyzed, because all nerves cells are affected.
Enter the hot chili pepper, in the form of capsaicin.
Enter, too, a failed derivative of the common anesthetic lidocaine, invented in the 1940s. The derivative, known as QX-314, was deemed useless because it couldn't penetrate cell membranes to block sensation. In non-pharmaceutical terms, that's a bit like having a power shovel that can't cut earth.
In experiments, the Harvard researchers found that the chili pepper ingredient generated heat that opened the gate to pain neurons, but had no similar effect on other nerve cells. Then, when they introduced the lidocaine derivative, it charged through the open channels to block pain in those neurons, but was still unable to enter other nerve cells, such as "motor" neurons that control coordination and mobility.
Thus, in rat experiments, there appeared to be a total shutdown of pain, with no apparent numbness or paralysis.
The rats received injections near nerves leading to their hind feet, and lost the ability to feel pain in their paws. But they continued to scamper about their cages normally and showed sensitivity to touch and other stimulation.
"We introduced a local anesthetic selectively into specific populations of neurons," said Bean. "Now we can block the activity of pain sensing neurons without disrupting other kinds of neurons that control movements or non-painful sensations."
Experimentation will likely move on to to sheep, then humans. One problem that needs to be addressed is whether the capsaicin might cause such a burning sensation when first injected -- before the lidocaine derivitive shuts down the pain -- that it may be too uncomfortable for use as an anesthetic. But the researchers are confident they can find a more practical "warming" chemical to open the gateways to the pain neurons.
"This method could really transform surgical and post-surgical analgesia. Patients could remain alert without suffering pain. But they also wouldn't have to cope with numbness or paralysis," Woolf said.
Noting that itch-sensitive neurons are similar to nerves that sense pain, he added: "We may have even found a good treatment for the common itch."
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Friday, September 28, 2007
Emotional response: Journal readers write about dealing with a patient's death
Comments have flowed in from around the world in response to an essay in the New England Journal of Medicine about clinicians' emotions when they are faced with a patient's death. From Greater Boston have come notes on saying goodbye before death, staying engaged at the worst times, coping with suicide, crying and celebrating with patients, and turning the tables when the doctor's time comes.
Doctors, nurses, students and others offered their thoughts in an online forum on Dr. Katharine Treadway's
Dr. Naomi Leeds of Massachusetts General Hospital commented that she wrote a letter to a patient dying of esophageal cancer to tell him how he had touched her life.
"I welcomed the opportunity for closure and was grateful that my colleague encouraged me to do this — I would not have thought to do this on my own," she wrote. "I think that we would all benefit by having more training on how to say goodbye and thank you to our patients who we know are going to die."
Dr. Robert Truog of Children's Hospital Boston said the essay gave him a chance to reflect on why he chose to specialize in pediatric intensive care medicine. Initially drawn to the challenge and excitement of making life and death decisions on a moment's notice, he has changed.
"In the long run, however, what has kept me most engaged in my specialty has been the opportunity to work with children and their parents through the worst times of their lives, helping them make decisions when none of the choices are good, and comforting them through the unimaginable depths of loss and sadness that accompany the death of a child," he wrote.
Death is "often uncommon and often traumatic for all involved" in child psychiatry, Dr. Steve Auster of Wellesley wrote. After a patient's suicide, clinicians met to talk about it and some of them attended the wake.
"Hard to imagine all that being possible in disciplines where death is more common, however that doesn't lessen the potential benefit of this processing," he wrote.
Stephanie Gill, a family nurse practitioner in Norwood, tries to put herself in the shoes of her patients.
"I've cried with them when it's bad news and celebrated with them when it's good news," she wrote. "I think the fact that we can make such a difference in someone's life (and in their death) is amazing."
And Dr. Thomas Amoroso of Quincy Medical Center said that spiritual rituals make him uncomfortable.
"To be honest, at my passing I want someone to make either a good joke, or best of all, a really bad pun," he wrote. "Honoring someone's life takes many forms, and I feel it is important to acknowledge that as well."
Wednesday, September 26, 2007
Journal asks: After a patient dies, how do doctors deal with their emotions?
It was more than 30 years ago, but Dr. Katharine Treadway (left) vividly remembers answering her first "code" call to revive a hospital patient.
The resuscitation attempt failed, and in this week’s New England Journal of Medicine she recalls what it felt like, as a freshly minted intern, to simply walk away from a life that had just ended.
“Someone had just died. But we all behaved as though that was not at all what had happened,” she writes. “We learned to bury our fear of death in an avalanche of knowledge. … And for good reason. We could not do what we do – take responsibility for the lives of our patients – if we were aware, minute to minute, of the true significance of what we were actually doing.”
The journal is publishing Treadway's essay to spark an online discussion, which the Boston-based publication calls Perspective Forum. Its physician readers are invited to write about how they cope with the emotions they put away while meeting clinical challenges.
Treadway, a Harvard Medical School faculty member and primary care doctor at Massachusetts General Hospital, writes that many doctors have private rituals they observe whenever a patient dies -- she says aloud, "May choirs of angels greet thee at they coming" -- but they rarely share them.
White Coat Notes asked Treadway what she would like to hear from readers, why she chose this topic, and what she teaches medical students about it.
What do you hope to hear in the forum?
What do you teach medical students about emotions?
What about situations like the code call?
There’s this tremendously fine line that we have to walk in terms of dealing with acute life-threatening situations in which you absolutely have to stifle your emotions. You can’t fling your hands into the air and say, 'Oh my god.' That wouldn’t help anyone.
How do you find that middle ground?
How about your own work?
Being a primary care doctor, I take care of my patients’ children, or their children’s children, or in one case, the great-granddaughter of my original patient. In addition to teaching medical students who are so eager and idealistic, it’s just so renewing. I feel very lucky.
Mass. General scores on two workplace lists
Massachusetts General Hospital has landed on two lists of best places to work.
One is the Working Mother magazine's 100 Best Companies, which considers compensation, child-care and flexibility programs, and leave policies. Harvard University also made the non-ranked list, along with Arnold Worldwide, The Boston Consulting Group and Massachusetts Mutual Life Insurance.
The other list is AARP's ranking of Best Employers for Workers Over 50, where it came in 10th. No other Massachusetts-based company made the list of 50 workplaces. The AARP considered recruiting practices; opportunities for development; and work options, such as flexible scheduling, job sharing, and phased retirement, in addition to health and retiree benefits.
Monday, September 17, 2007
MGH names patient-care institute head
Gaurdia E. Banister (left) has been named the first executive director of The Institute for Patient Care at Massachusetts General Hospital, which includes centers for nursing research and professional development.
A registered nurse with a doctorate in psychiatric/mental health nursing, she had been senior vice president for patient care services at Providence Hospital in Washington, D.C., part of the Ascension Health System.
Thursday, August 16, 2007
New physician-scientists win Howard Hughes awards
Seven Boston physicians who spent a year or more away from medical school doing research have won grants to continue their dual roles as scientists and clinicians.
The Howard Hughes Medical Institute has given Early Career Awards of $375,000 each over five years to 20 doctors to make sure they have the time and financial support for research early in their careers, it said in a statement. Their institutions agreed to allow these tenure-track physician-scientists to devote at least 70 percent of their time to research.
The winners are alumni of either HHMI's research scholars or training fellowship programs, which bring students to the National Institutes of Health or other institutions. They are:
Dr. Sarah Fortune, Harvard University School of Public Health
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Friday, August 3, 2007
MGH research center to focus on heart arrhythmia and stroke
Massachusetts General Hospital has created The MGH Deane Institute for Integrative Research in Atrial Fibrillation and Stroke, the hospital said today.
Funded by a $10 million gift from MGH donors Disque and Carol Deane, the center will combine efforts of the cardiac arrhythmia service led by Dr. Jeremy Ruskin and the stroke service headed by Dr. Karen Furie to improve prevention and treatment of strokes related to atrial fibrillation.
Tuesday, July 24, 2007
Mass. General surgeons win suit brought by Notre Dame coach
A jury today found in favor of two Massachusetts General Hospital surgeons who had been sued for malpractice by University of Notre Dame football coach Charlie Weis, who bled internally after gastric bypass surgery five years ago.
The Suffolk Superior Court jury found that surgeons Charles Ferguson and Richard Hodin were not negligent in their care of Weis, former offensive coordinator of the New England Patriots who nearly died after the 2002 obesity surgery and testified that he still has difficulty walking.
Internal bleeding is a known complication of gastric bypass surgery, and the doctors argued that they waited to perform a second operation to stop the bleeding because they thought it would stop on its own and were concerned about risks of further surgery.
The first trial of the malpractice suit ended dramatically in a mistrial in February, after the surgeons rushed to the aid of a juror who had collapsed in the courtroom.
Wednesday, July 18, 2007
NEJM: Leaving against medical advice
In tomorrow's New England Journal of Medicine, a first-year internal medicine resident at Massachusetts General Hospital, writes an eye-opening essay about his experience treating a critically ill patient who, against medical advice, decided to leave the hospital.
The patient, a 29-year-old heroin addict who spoke only Spanish, was hospitalized with a heart infection and failing heart, among other problems.
"We tried deals and scare tactics, telling him as clearly as we could that he was more likely to die if he left this way," writes Dr. Viviany R. Taqueti. "When he countered with 'that is up to God,' we offered him consultation with a priest. An interventionalist, overhearing this exchange, called us warm and fuzzy. Our efforts felt futile, and we were weary. Yet it seemed wrong not to keep trying."
Later, Taqueti writes, "I listened to his heart one more time ... I heard those ominous rumbles and screeches, and they startled me with their threat of impending death, obvious even to me. But (the patient) could not hear them, and I wondered how much of his failure to hear was due to our failure to translate.
"I placed the stethoscope in his ears. (The patient) raised his eyebrows in astonishment but said nothing. I knew this simple hearing aid could not remedy his deafness, arising as it did from barriers of language, culture, denial, distrust, and drug dependency. I was left frustrated, sad, and tired."
Friday, July 13, 2007
On the blogs: Levy ponders surgeons' report card Catch-22
Public reporting campaign meets surgical caution on Running a Hospital today.
In this week's New England Journal of Medicine three Harvard doctors argue that making mortality rates public for individual cardiac surgeons could end up harming patients if the rankings push surgeons to avoid operating on high-risk patients.
Today Paul Levy responds in detail to the White Coat Notes post about the opinion piece in the journal, written by Dr. Thomas H. Lee of Partners Health Care, Dr. David F. Torchiana of Massachusetts General Hospital and Dr. James E. Lock of Children’s Hospital Boston.
As readers of the Beth Israel Deaconess CEO's blog know, Levy is a champion of transparency, urging other hospitals to join his in posting their performance measures. He responds to the doctors' contention that public reporting is too flawed (not adequately adjusted for risk, too small a sample) to be valid. (He also asks many questions -- it's a long entry.)
"So here's our Catch-22: No reporting method is statistically good enough to be made public," he writes. "But if a method is statistically good enough, we won't allow it to be made public."
Then Levy issues a challenge to health care providers:
"The medical profession simply has to get better at this issue. If they don't trust the public to understand these numbers, how about just giving them to referring primary care doctors? Certainly, they can trust their colleagues in medicine to have enough judgment to use them wisely and correctly."
And another to insurers:
"We hear a lot about insurance companies wanting to support higher quality care. When is an insurance company going to demand that the hospitals in its network provide these data to referring doctors in its network? How about this for an idea? If a hospital doesn't choose to provide the data, it can still stay in the network, but the patient's co-pay would be increased by a factor of ten if he or she chooses that hospital."
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MGH, Brigham make US News honor roll
Massachusetts General Hospital and Brigham and Women's Hospital held on to their honor roll positions in the annual rankings by U.S. News & World Report called "America's Best Hospitals." Nine Boston hospitals are featured in the guide.
Mass. General finished fifth in the standings, down one rung from last year, and the Brigham took tenth place, up one from last year. Once again, Johns Hopkins Hospital and the Mayo Clinic finished first and second. UCLA Medical Center moved up to third from fifth and the Cleveland Clinic slipped to fourth from third.
The magazine evaluated 5,462 hospitals in 16 specialties, excluding pediatrics, and came up with 173 hospitals that met standards in one or more specialties based on reputation, care-related factors such as nursing and patient services, and mortality rate. Eighteen hospitals scored at or near the top in at least six specialties to make the honor roll.
Other hospitals were ranked in the specialty areas, but not in a cumulative score. Beth Israel Deaconess Medical Center was in the top 50 for 10 categories: diabetes (in conjunction with the Joslin Clinic); digestive disorders; respiratory care; heart and heart surgery; cancer care; kidney diseases; geriatrics; gynecology, urology; and ear, nose and throat care.
Boston-area hospitals known for their specialties also made the top 50. Dana-Farber Cancer Institute placed fifth in the list for cancer care. Joslin Clinic, with its partner Beth Israel Deaconess, was ranked 12th for endocrinology. New England Baptist Hospital was 17th for orthopedics and Spaulding Rehabilitation Hospital ranked eighth for rehabilitation. Massachusetts Eye and Ear Infirmary placed fourth in ophthalmology and in the ear, nose and throat specialty.
Boston Medical Center was ranked 41st in geriatrics.
Mass. General's winning specialty areas were cancer; digestive disorders; ear, nose and throat; endocrinology; geriatrics; heart and heart surgery; gynecology; kidney disease; neurology and neurosurgery; orthopedics; respiratory disorders; urology; psychiatry; and rheumatology.
The Brigham's top specialties were cancer; digestive disorders; ear, nose and throat; endocrinology; geriatrics; gynecology; heart and heart surgery; kidney disease; neurology and neurosurgery; orthopedics; respiratory disorders; urology; and rheumatology.
Wednesday, July 11, 2007
Surgeon rankings have unintended consequences, doctors say
Dr. Thomas H. Lee knows the headline he wrote is provocative: "Is Zero the Ideal Death Rate?"
"If you are being ranked, you may walk away from a patient who’s very sick, even though that patient may be at high risk for surgery but even higher risk with medicine" as treatment, he said in an interview. "When so few patients can swing things for you being ranked, we’re worried about that effect on the decision-making process."
Lee, along with co-authors Dr. David F. Torchiana, a cardiac surgeon at Massachusetts General Hospital, and Dr. James E. Lock, an interventional cardiologist at Children’s Hospital Boston, say that reporting on cardiac surgery by institution makes sense, with individual reports available only to those hospitals. Massachusetts recently joined New York, New Jersey and Pennsylvania in publicly reporting death rates for individual cardiac surgeons.
Two elements make individual reports undesirable, they said. The first problem is that risk-adjustment methods intended to account for how sick a patient is do not include variables such as socioeconomic status. The second problem is the small sample size. If the average death rate after coronary artery bypass surgery is 2 percent, one or two deaths among the 200 operations a surgeon performs can make a large difference in that surgeon’s ranking, the authors say.
"I worry about having a patient with diabetes who’s doing very poorly. They may have a 20 percent mortality rate with surgery but an 80 percent mortality rate without surgery," he said. "I don’t want to have to beg surgeons to operate."
Tuesday, June 26, 2007
MGH doctor lobbies for childhood cancer research
By Elizabeth Cooney, Globe Correspondent
Dr. Howard Weinstein (left) has been caring for children with cancer and researching ways to treat them for 30 years, but he's never seen so many clinical trials stalled for want of funding.
That's why the chief of the center for pediatric hematology and oncology at Massachusetts General Hospital was on Capitol Hill this afternoon. About 300 people from across the country -- cancer doctors, parents of children who died of cancer and families with children who survived -- were all lobbying for passage of a bill called the Childhood Cancer Act of 2007.
"Twenty trials that are ready to be launched will not be activated in the next weeks to months because of the budget," he said in an interview. "It's such a frustrating time because there's an explosion of new drugs that we're really anxious to test in children, but we don't have the funding."
The National Cancer Institute provides about $28 million a year for studies of childhood cancer, but the field could use double that amount, Weinstein said. Four years of flat funding for the National Institutes of Health have meant real declines in the money available for research, after medical inflation is taken into account.
The bill asks for $150 million over five years to pay for studies organized by the Children's Oncology Group, a group of cancer centers around the country formed seven years ago to coordinate research. The bill would also support families and establish a national childhood cancer registry.
"Twelve thousand children a year are diagnosed with cancer," he said. "I think our job is to make sure every child in this country with cancer has the opportunity to be cured."
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Friday, June 22, 2007
Harvard researcher wins MERIT Award from NIH
Xihong Lin (left), professor of biostatistics at the Harvard School of Public Health, has won a MERIT Award from the National Institutes of Health.
Lin will develop statistical methods for analyzing cancer research data, including long-term and family data as well as genomic and proteomic information in epidemiological studies and population sciences, NIH said in a statement.
Fewer than 5 percent of NIH-funded investigators are selected to receive the awards.
Current MERIT recipients in Massachusetts and their instituions are:
Beth Israel Deaconess Medical Center: Benjamin G. Neel
Thursday, June 21, 2007
NCI cancels breast cancer prevention study
By Elizabeth Cooney, Globe Correspondent
In an unusual step, the National Cancer Institute has canceled a $130 million clinical trial to compare how well two drugs prevent breast cancer.
Called the P-4 trial because it is the fourth such prevention study undertaken by the federal agency, it would have enrolled more than 12,000 women at high risk for breast cancer at 500 sites and followed them for years. The termination of the study before it began recruiting patients comes at a time when NCI is straining under four years of tight budgets.
The women would have received either raloxifene, an estrogen-blocking drug approved to treat osteoporosis but now prescribed to stop breast cancer, or letrozole, a compound from a newer class of drugs called aromatase inhibitors that deplete the production of estrogen. Both target estrogen because it promotes the growth of cancer cells.
Dr. Bruce Chabner, clinical director of the Massachusetts General Hospital Cancer Center, was on a scientific panel that last week advised NCI director Dr. John E. Niederhuber to pull back the P-4 trial. Niederhuber, who called for a review of the trial in January, visited Mass. General Monday and discussed the trial in previously scheduled sessions with Boston researchers and clinicians.
Chabner said the trial's cost was considered along with scientific concerns, including the desire to better match powerful drugs with the individuals who can be helped by them.
"I think in times when the budgets were really generous the NCI would probably have gone ahead with the study. It's not so much a criticism of the trial as it's expensive when there are other priorities that are very important," he said. "It is an unusual step. But these are unusual times."
The NCI's June 19 letter to the study's principal investigators at the University of Pittsburgh cited troubling complications caused by the two cancer prevention drugs and the relatively small number of women -- 3 or 4 out of 100 -- who benefit from them. The decision not to go forward with the study was first reported in Wednesday's Washington Post.
"While the P-4 study may provide another possible option for women at risk for breast cancer, the dangers of introducing these drugs, with their many known side effects, outweighs their potential until we are better able to determine who will benefit from these interventions and what the longer-term effect may be," the letter said.
Tamoxifen -- studied in 20,000 women in the P-1 trial of the early 1990s -- is currently the only drug approved for the prevention of breast cancer. Doctors prescribe it to treat women with breast cancer, to avoid a recurrence or in some cases to prevent it in the first place. Tamoxifen and raloxifene were compared in a large trial that last year reported they had just about the same effectiveness in preventing cancer, but raloxifene had fewer side effects.
Tamoxifen is linked to uterine cancer, blood clots and cataracts. Raloxifene was associated with a lower risk of these complications. Aromatase inhibitors are known to cause brittle bones, a particular worry for older women who might be taking them.
Chabner said the advisory panel's consensus was that this expensive trial was "not going to change the practice of medicine."
"Everybody agrees that the number-one priority is not to compare drug X to drug Y," he said. "It's to really define who is at highest risk for breast cancer so we don't have to treat 100 patients to prevent three or four or five cancers. If we can treat 10 patients and prevent 5 cancers, then it's going to be more reasonable."
NCI holds out hope for personalized medicine to better fit treatments to patients.
"Targeted chemoprevention must rely on individual genomic and proteomic signatures to identify those patients for whom the risk-benefit ratio justifies using a chemopreventive drug," its letter said. "NCI will continue to have a strong commitment to cancer prevention and search for ways in which such patients can be provided highly personalized approaches to prevention."
Other ongoing studies are examining how well other aromatase inhibitors protect women against breast cancer compared with placebos. One trial, funded by the National Cancer Institute of Canada and looking at exemestane, is led by Dr. Paul E. Goss, also of Mass. General.
Chabner said another weakness of the P-4 trial was that letrozole, the aromatase inhibitor being compared with raloxifene, will no longer be protected by its patent in 2011, meaning its manufacturer will have no incentive to seek FDA approval if it is shown to be effective.
Dr. Harold J. Burstein, a breast cancer specialist at the Dana-Farber Cancer Institute, said oncologists will have to infer from other studies in other countries how the different kinds of chemoprevention drugs compare. Dana-Farber would likely have been one of the many sites for the P-4 trial, he said.
"There's no doubt we need more studies in breast cancer prevention and the study being proposed was a very practical strategy to compare two likely effective strategies," he said. "There will be a void when a patient comes to see a doctor eight years from now and says, 'Which one should I take?'"
Tuesday, June 19, 2007
Boston scientists named Pew biomedical scholars
Four Boston-area scientists are among the newest class of 20 Pew Scholars in the Biomedical Sciences, the program announced today.
Funded by the Pew Charitable Trusts through a grant to the University of California at San Francisco, the awards give each scientist $240,000 over four years to support research.
Past winners have included Craig C. Mello of the University of Massachusetts Medical School, who shared the 2006 Nobel Prize in medicine or physiology for the discovery of the gene-silencing mechanism know as RNA interference.
This year's Boston-area winners are:
Ekaterina Heldwein (left), an assistant professor at Tufts University, will study how herpes viruses enter human cells. A graduate of Oregon Health and Science University, she trained at Children’s Hospital Boston and Harvard Medical School.
Dr. Deborah T. Hung (right), an assistant professor at Harvard Medical School and an assistant molecular biologist at Massachusetts General Hospital, will search for ways to fight the infectiousness of Pseudomonas aeruginosa, a bacterium that harms people with compromised immune systems because they have such conditions as cystic fibrosis, HIV or traumatic burns. She earned a doctorate in chemistry and a medical degree from Harvard and did additional training at Brigham and Women’s Hospital and Mass. General.
Thomas U. Schwartz (left), an assistant professor at MIT, will study the three-dimensional structure of the nuclear pore complex that regulates molecular traffic into and out of the cell nucleus, which could lead to antiviral therapies. He earned a doctorate in biochemistry from the Free University of Berlin and did postdoctoral research at Rockefeller University.
Monday, June 18, 2007
NCI director discusses budget realities
The director of the National Cancer Institute said today that researchers around the country are telling him their labs are cutting staff and trimming some goals of their research while they turn to philanthropic support to make up the shortfall in government grants.
"There is real pain in individual labs," Dr. John E. Niederhuber (left) told a group of cancer and stem cell specialists gathered in the Ether Dome at Massachusetts General Hospital. "They are dangerously close to the point that the amount of dollars doesn’t allow the job to be done."
He hears from individual investigators worried that "big science" –- which he prefers to call "team science" -- will divert funding from small projects in favor of broader efforts. He said there's room for both, even in an era of stiffer competition for initial awards and of grant renewals with their value eroded by inflation.
"The world has changed. The technology available to researchers today has changed. It couldn’t go forward unless we invest in teams," he said, pointing to last week’s reports of stem cell scientists turning back the developmental clock in mature mouse cells so that they behaved like embryonic stem cells, regaining the potential to become any kind of cells.
The researchers gathered in the historic surgical amphitheater may have wanted to turn the clock back to 1998 through 2003, a period during which the NIH budget doubled. The budget for the cancer institute, like that of the rest of the National Institutes of Health, will fall next year once inflation is factored into the 1.5 percent increase over 2007 levels that a House subcommittee is considering, Niederhuber said. This follows four years of flat budgets.
Dr. David M. Livingston of Dana-Farber/Harvard Cancer Center pressed Niederhuber on how well he was communicating to Congress and to concerned scientists the need to sustain work that was launched during the doubling era.
"The degree of success in discovery has jumped geometrically," he said. "The budget was always a way of letting Congress know just how urgent the need was for funds" to shorten the time to translate research into patient care.
Niederhuber, defending his efforts, said he tells Congress science has never moved more rapidly than today.
"I remind them we simply can't lose this opportunity to invest in biomedical science," while still being realistic, he said.
The result is "more a reflection of where we are in society and the demands on our budget," he said.
Neurontin fine funds program on drug industry influence
A Boston health educator is taking a page from the antismoking playbook.
Using money from a $430 million Pfizer Inc. settlement of illegal marketing charges, the MGH Institute of Health Professions is launching a program today to teach health care providers about drug industry influence. Just as tobacco company settlement dollars funded stop-smoking campaigns, a total of $21 million and 26 grants were earmarked nationwide to bring information about pharmaceutical marketing to prescribers and consumers.
Elissa Ladd (left), clinical assistant professor at the affiliate of Massachusetts General Hospital, won $399,400 to develop a documentary called "PERx: Prescribing Evidence-Based Therapies" and a companion website. Both are funded through fines paid by the drug giant Pfizer in 2004 when its Warner-Lambert subsidiary pleaded guilty to promoting unapproved uses for the anti-seizure drug Neurontin.
"As a practicing nurse practitioner, I was struck with the fact that pharmaceutical promotional activity was ubiquitous in our world, both as providers and consumers," Ladd said in an e-mail interview. "I felt that this promotional activity was driving the appetite in our culture for medications."
The documentary, produced by filmmaker and former pharmaceutical sales rep Kathleen Slattery-Moschkau, includes interviews with Dr. Jerry Avorn of Brigham and Women's Hospital, Dr. David Blumenthal of Mass. General, Susan M. Reverby of Wellesley College and Kenneth Kaitin of the Tufts Center for the Study of Drug Development.
While the materials were crafted as continuing medical education, the website and film are available to the public, Ladd said.
"The important outcome of this project is that prescribers of all health care professions develop an appreciation that the overuse and sometimes unnecessary prescription of expensive brand-name medications can negatively impact our overburdened health care system," she said. "Ultimately it is our patients who will suffer from the undue burden that these costs are generating."
Friday, June 15, 2007
MGH Institute picks president
Janis P. Bellack (left) has been named president of the MGH Institute of Health Professions, an independent graduate school and academic affiliate of the Massachusetts General Hospital.
Bellack had been vice president for academic affairs/provost and professor of nursing and health sciences at the Massachusetts College of Pharmacy and Health Sciences. She will succeed Ann W. Caldwell, who announced in September that she would step down after 10 years as president.
Bellack earned a bachelor's degree in nursing from the University of Virginia, a master’s degree in pediatric nursing from the University of Florida, and a Ph.D. in educational policy studies and evaluation from the University of Kentucky.
Wednesday, June 13, 2007
The revolution will be e-mailed
A quiet revolution in health care has begun with the growth of secure e-mail communication, Dr. John H. Stone writes in tomorrow’s New England Journal of Medicine.
Web visits in which doctors answer patients’ non-urgent questions aren’t the only services e-medicine can enable, he said. He describes a transition that came about at his clinic in part as self-preservation in the face of round-the-clock contacts flooding office, clinic and home phones and fax machines.
Stone directed the vasculitis center at Johns Hopkins until recently becoming deputy editor for rheumatology at UpToDate, a subscription-based provider of clinical information in Waltham. He will soon resume clinical work part-time at Massachusetts General Hospital.
Appointment scheduling, prescription refills, and messages about routine issues (such as whether an X-ray is needed before a visit) were moved to e-mail.
"In time, secure e-mail communication among patients, physicians, and medical centers (hospitals, emergency rooms) will become the norm, because it is efficient and makes sense," Jones said in an interview (by e-mail).
His clinic had to overcome concerns about privacy and security and get around compatibility issues for e-mails to become part of the patient’s record. And even if patients were frustrated by the trouble they had reaching their doctors by telephone, they weren’t necessarily ready to pay for Web consultations, which Stone says cost from $10 to $25. Physicians need to be compensated in order for this kind of communication to be a success, he said.
"The extra effort cannot simply be added on to the rest of their work day (and evening)," he said.
The payoff comes not only in convenience, but also in safety, he argues. E-mail between doctors, hospitals, pharmacies and other parts of the healthcare system have the potential to improve medical care by bridging gaps between them.
In a health policy report also appearing in this issue, Dr. David Blumenthal and John P. Glaser of Massachusetts General Hospital discuss the implications of health information technology for doctors, patients and the healthcare system.
Monday, June 11, 2007
On the blogs: lab waste, hospital competition
On Nature Network Boston, Anna Kushnir lets us in on a dirty little secret: Labs are an environmentalist's nightmare.
"The amount of waste that my lab generates every day makes paper mills look Earth-friendly," she writes reluctantly (while noting it's not her waste bucket at left). "There is nothing I can do about it. I am not willing to risk my samples being contaminated and my experiments failing to save a pair of gloves or spare a pipette."
A Healthy Blog's John McDonough of Health Care For All and Running a Hospital's Paul Levy of Beth Israel Deaconess Medical Center are engaged in a back-and-forth on hospital competition, cost and quality. This follows previous discussions about the power of Partners HealthCare to influence payment rates.
Levy asks. "Since BIDMC has and will continue to have an excellent clinical reputation and very good relationships with community hospitals, multi-specialty groups, and other referring physicians, should we abandon our call for structural changes in the payment system? Would we be better off just living with the current arrangement, i.e., receiving rates that are just below those provided to the dominant provider network?"
McDonough lists financial data for Beth Israel Deaconess and two Partners hospitals, Massachusetts General and Brigham and Women's.
"Yes, BIDMC’s major competitors are bigger and badder," he writes. "Doesn’t seem, though, that BIDMC is doing too shabbily itself. Doesn’t seem like it’s time to take the hankies out."
That said, McDonough asks how to measure quality in hopes of moving the converstation forward.
"There are literally hundreds and hundreds of quality indicators, and each provider would like to get paid for those things it does well, and not get penalized for the things it does poorly," he says. "Who should decide which indicators matter, and which do not?"
Friday, June 8, 2007
Study suggests men at risk for heart attack should be evaluated before starting hormones for prostate cancer
Men who are at risk for a fatal heart attack should be evaluated by a cardiologist before beginning hormonal therapy to treat prostate cancer, researchers from Harvard Medical School report.
The article to appear Sunday in the Journal of Clinical Oncology follows a landmark paper by other Harvard doctors published last fall in the same journal (and reported in the Globe) that linked androgen suppression therapy to diabetes and heart disease.
Androgen suppression therapy is often prescribed for men with prostate cancer. Research has established that it improves survival rates in men with advanced stages of the disease when given with radiation therapy, but the benefits of the treatment are not as clear in men whose cancer is in earlier stages.
In the newer work, researchers led by Dr. Anthony V. D'Amico of Harvard and Brigham and Women's Hospital analyzed data from three randomized trials of 1,372 men in Australia and New Zealand, Canada and the United States. They report that nearly half of the men who were 65 and older and had heart disease risk factors suffered heart attacks sooner if they had received androgen suppression therapy for six months compared to men who had not been given the therapy.
Men who smoke or have diabetes, which put them at risk for heart attacks, should be referred for a cardiac evaluation before they start hormonal therapy to treat prostate cancer, D'Amico said in an interview.
"The study shows that a significant fraction of these men who are going to have heart attacks will have them on average 2 to 3 years sooner if the underlying heart disease is not addressed," he said.
D'Amico said his study's results "fit perfectly " with data produced by Dr. Nancy L. Keating of Brigham and Women's and Dr. Matthew R. Smith of Massachusetts General Hospital. They found that among 73,000 Medicare patients, men who received hormonal therapy significantly increased their risk of developing diabetes and also raised their risk of heart disease.
"The landmark study by Keating put on the map the issue of treatment-related diabetes and cardiovascular disease," Smith said. "Great care needs to be taken in interpreting the results of other trials because of the relatively small number of events and because the studies weren't designed to look at cardiovascular disease."
D'Amico said men can safely delay hormonal therapy to seek treatments for heart disease, which can range from taking aspirin to having stents placed to prop open clogged coronary arteries.
"Hormone therapy can cause a heart attack sooner than prostate cancer can progress," he said.
Wednesday, June 6, 2007
Harvard, Whitehead scientists report embryonic stem cell advances
By Colin Nickerson, Globe Staff
Scientists in Massachusetts and Japan say they have created embryonic stem cells using procedures that might overcome some of the ethical objections to the controversial research as well as a major scientific hurdle.
Most dramatically, three of the four research findings announced today used a highly experimental approach that avoids the destruction of embryos, which critics equate to taking a life. Instead, they used genes and retroviruses to coax adult cells back to an embryo-like state.
The other project, meanwhile, points to a new, readily available source of embryonic stem cells, which would allow researchers to bypass a bottleneck in current efforts at Harvard University to clone human stem cells genetically matched to a patient with a particular disease -- the inability to find women willing to donate unfertilized eggs for the research.
All of the research reported in today's Nature and Cell Stem Cell involved mice, but scientists say they believe the results could be replicated in humans.
"These new studies, done with mice cells, point the way to experiments that can be tried with human cells," said Douglas Melton, a Harvard stem cell scientist. "This represents some of the most exciting work in stem cell biology and genetic reprogramming."
In one of the papers, Melton's colleague at the Harvard Stem Cell Institute, Kevin Eggan, defied long-standing scientific dogma that fertilized eggs cannot be used to clone embryonic stem cell lines. Eggan carried out somatic cell nuclear transfer -- cloning -- by removing chromosomes from a one-cell fertilized egg and replacing it with DNA from another, mature cell. The modified cell began dividing, and he then harvested stem cells from the resultant embryo.
Although less razzle-dazzle than the techniques used in the other research, Eggan's work holds the best prospect of creating human embryonic stem cell lines in the near future.
The study by Eggan suggested that researchers could use the genetically-defective fertilized eggs discarded by the thousands daily at fertility clinics across the United States. Such one-cell embryos are treated as waste because they stand no chance of attaching to the womb and forming a healthy embryo.
"This represents a wonderful way of obtaining something good -- medical research that could lead to therapies for human disease -- out of something that would just be thrown away," Eggan said in an interview.
The findings by scientists from Harvard, the MIT-affiliated Whitehead Institute, Massachusetts General Hospital, and Japan's Kyoto University also represented the most successful attempts to date to find new ways to make embryonic stem cells that might overcome some of the ethical opposition from religious groups who oppose destruction of human embryos and from womens groups worried about the implications of female donors undergoing tricky hormonal therapy to produce eggs for research.
"All in all, this is encouraging, exciting progress that shows real willingness among scientists to weigh ethical concerns even as they pursue science objectives," said Dr. William Hurlbut, a neuroscientist and ethicist at Stanford University who serves on the President's Council on Bioethics. "The science is critical, of course. But so are many ethical concerns. We've got to calm down as a nation and stop the acrimony and misrepresentation flung by both sides."
Embryonic stem cells, considered crucial to medical science and eventual treatment for an array of terrible diseases, have the ability to form any of the 220 basic tissue types in the body -- from bone cells to brain cells.
But research on the cells has been slowed in the United States since President Bush, citing concerns about destruction of embryos, sharply limited federal funding of the science in 2001.
Work done by teams working independently of one another at Harvard, the Whitehead Institute, and Kyoto University involved the genetic manipulation of mouse skin cells back into an embryonic state. No eggs were used, no embryos destroyed -- a stunning advance, although perhaps difficult to replicate in humans.
"You can really turn back the clock from adult to embryonic stem cells," said Konrad Hochedlinger of the Harvard Stem Cell Institute and Massachusetts General Hospital's Center for Regenerative Medicine. "But success in humans might be much more difficult than in mice."
Thursday, May 24, 2007
State approves Mass. General expansion plan
By Stephen Smith, Globe Staff
The state's Public Health Council today unanimously approved a major expansion at Massachusetts General Hospital that will increase the number of operating suites, add more private rooms, and allow ambulances to arrive protected from the weather and prying eyes.
The heart of the nearly $500 million expansion is a new 10-story building that will rise in the shadow of the hospital's iconic entrance on Fruit Street. The total number of beds at Mass. General will increase from 902 to 1,052, while the roster of operating rooms will grow from 52 to 71.
The project is expected to be completed by October 2011, and hospital administrators pledged that the new tower will be built to high environmental standards.
Regular crowding in the emergency room was cited as a prime reason for the expansion. Patients wait on average 7 to 8 hours in the hospital's bustling room because there aren't beds available elsewhere in the hospital to accept cases.
"If you ask me what keeps me awake at night, it's the fact that we have overcrowding in our emergency department," said Dr. Alasdair Conn, chief of emergency medicine at Mass. General. "Frankly, it gets very cramped. But emergency department overcrowding is not an emergency problem -- it's a hospital overcrowding problem."
As part of its deal with the state to win approval for the expansion, Mass. General is pledging to spend $18.6 million on community initiatives to address substance abuse, violence and healthcare disparities.
Monday, May 21, 2007
In case you missed it: dream team
The same doctors who treat Tom Brady, Tedy Bruschi and other New England Patriots players will soon be available to examine the knee your kid sprained at soccer practice, Christopher Rowland reports in Sunday's Globe.
Dr. Bertram Zarins and Dr. Thomas J. Gill, Massachusetts General Hospital orthopedic surgeons who serve as Patriots team doctors, will be among the marquee physicians who will work next year at a new sports medicine center and outpatient surgical clinic in Foxborough, part of the Patriot Place commercial complex the Kraft family is building around Gillette Stadium.
Monday, May 7, 2007
CIMIT awards $5m to medical device researchers
Proposals to build new devices to help premature infants, to inject medicine without breaking the skin and to guide surgeons operating on the brain were among projects to win $5 million in grants from the Center for Integration of Medicine and Innovative Technology, the consortium announced today.
CIMIT, composed of Boston-area teaching hospitals and engineering schools, made 37 grants that range from $40,000 to $100,000. Twenty-two have military applications, acording to CIMIT, which receives support from the US Department of Defense as well as its members.
Dr. Riccardo Barbieri of Massachusetts General Hospital won a grant to develop a computational tool based on a premature infant's heartbeat to predict episodes when they stop breathing.
Mark Horenstein of Boston University will demonstate a way to inject medications through the skin using nanoparticles, leaving no wound behind.
Dr. Nobuyuki Nakajima of Brigham and Women's Hospital will work to improve how instruments can be navigated to diagnose and treat brain injury or disease.
"Our goal ... is to bring life-changing technology to patients as quickly as possible," Dr. John Parrish, CIMIT founder and director and Vietnam War battlefield surgeon, said in a statement. "We are especially aware of the needs of soldiers wounded on the battlefield."
Thursday, May 3, 2007
Pancreatic surgery up close
The program promised high-definition images of pancreatic surgery. What it delivered was part of the organ itself.
About 40 doctors crowded into a conference room at Massachusetts General Hospital today to watch a live broadcast of surgery to remove a growth from a patient's pancreas, to see whether it was malignant or benign. They were there to learn about finding early forms of pancreatic cancer as the hospital introduced its new pancreatic-biliary program.
During the operation, surgeon Dr. Carlos Fernandez-del Castillo asked Dr. Gregory Lauwers, a pathologist who had gone to the conference room, to return to the operating room to examine part of the pancreas he had just cut out and solve the mystery.
A few minutes later, Lauwers, director of gastrointestinal pathology at MGH, appeared back in the conference room with the answer -- and the reddish tissue in a metal tray. Wearing gloves, he turned the tissue with a metal instrument to show the group.
The doctors rose from their chairs to crowd around and peer at the piece of pancreas, about the size of a child's fist. It turned out to be benign, in the judgement of Lauwers and another pathologist who later examined a frozen section under a microscope.
Then the doctors, including the one who had sent the patient for surgery, discussed how hard it is to know in advance who needs to have such growths removed.
Pancreatic cancer is the fourth leading cause of cancer death, in part because it is so difficult to detect before it has grown and spread. A small subset of tumors are benign growths, some of which later become malignant. The challenge is to know which ones, they said.
Tuesday, May 1, 2007
MGH leads drug maker Lilly's list of grants
Massachusetts General Hospital's psychiatry department got the largest single grant -- $825,000 -- from drug maker Eli Lilly & Co. in the first quarter of 2007, according to today's Wall Street Journal.
The Indianapolis pharmaceutical company will release a report today that for the first time details how much it gives to nonprofit groups and educational institutions, the story said. In the first quarter the grants totaled $11.8 million.
"We issued a challenge to the pharmaceutical industry: You say you believe in [continuing medical education], then give to academic institutions without any direct knowledge of what the curriculum will be," Dr. Jerrold Rosenbaum, psychiatrist-in-chief at Massachusetts General Hospital, told the Journal. Lilly isn't the only drug company to fund his program, but that support does not affect the content, he said.
Lilly's move comes amid criticism that money from drug companies is exerting an unhealthy influence on medicine, the story said.
Friday, April 27, 2007
This week in Science
Two papers in Science, including one by Harvard researchers, were among four published yesterday in Science and Nature Genetics on genetic risk factors for developing diabetes. Alice Dembner describes them in today's Globe.
Reseachers from Massachusetts General Hospital, Dana-Farber Cancer Institute, Beth Israel Deaconess Medical Center and Brigham and Women's Hospital are part of an international team reporting on a new mechanism involved in resistance to "smart" cancer drugs Iressa and Tarceva that target lung cancer cell growth.
Scientists have identified a new gene that helps regulate the body's clock and Giulio F. Draetta of Merck
A team that includes researchers from the CBR Institute for Biomedical Research and Harvard Medical School in Boston reveal how the influence of micro-RNAs, small RNA molecules that regulate gene expression, extends to the immune system.
Thursday, April 26, 2007
Newton-Wellesley opens joint reconstruction center
Newton-Wellesley Hospital has opened a new center for joint reconstruction surgery in collaboration with Massachusetts General Hospital.
Dr. Joseph C. McCarthy (left), who came to Newton-Wellesley from New England Baptist Hospital in September, was named director of the Jim and Ellen Kaplan Center for Joint Reconstruction Surgery when it opened Monday. A $1 million gift from the Kaplans will help fund three new operating rooms in the center.
McCarthy was also appointed vice chair for program development in orthopedic surgery at Mass. General.
Aronson, Rosenbaum honored for career achievements
Dr. Mark D. Aronson of Beth Israel Deaconess Medical Center and Dr. Jerrold F. Rosenbaum of Massachusetts General Hospital are being honored for liftime contributions to their fields.
Aronson has won the Society of General Internal Medicine's Career Achievement in Medical Education Award. He founded Beth Israel's hospital medicine program, incorporating it into the residency curriculum and into continuing education and graduate medical education at Harvard Medical School.
Rosenbaum, chief of psychiatry at MGH, has won the C. Charles Burlingame Award from the Institute of Living in Hartford. He specializes in treatment-resistant mood and anxiety disorders, focusing on drug treatments for those conditions.
Wednesday, April 25, 2007
More than a quarter of doctors paid by industry, survey shows
Lunch in the doctor's office courtesy of pharmaceutical company reps and payments to physicians who speak at conferences aren't new, but the proportion of physicians reporting that they get money from industry and how that varies by specialty may be important for efforts to control these relationships, according to an article in tomorrow's New England Journal of Medicine.
Researchers at the Institute for Health Policy at Massachusetts General Hospital and Harvard Medical School conducted a national survey of 3,167 physicians and found that 94 percent had some kind of relationship with the pharmaceutical or medical device industries. The respondents reported receiving drug samples (78 percent), gifts of food (83 percent) and sports or cultural event tickets (7 percent). More than a third (35 percent) received reimbursement for continuing medical education or meeting expenses.
More than a quarter (28 percent) got paid for consulting, serving on an advisory board or speakers bureau, or enrolling patients in clinical trials. This surprised the authors more than the 94 percent of doctors with some sort of tie, which could have been as little as a mug or pen, Dr. David Blumenthal said.
"I figured that direct payments went pretty much to people who were academic or opinion leaders, but it seemed to be far more common," he said in an interview. "The fact that more than a quarter of physicians are actually getting direct monetary payments tells me this remains an important phenomenon in American medicine and that the rules and regulations put into effect have not eliminated it."
In 2002, the Pharmaceutical Research and Manufacturers of America, the industry's trade group, put in place voluntary guidelines limiting certain gifts. Leading physician groups have also adopted similar rules.
Pediatricians were less likely than internists to receive payments or reimbursements. Anesthesiologists didn't get samples, reimbursements or payments as often as family practitioners, internists or cardiologists.
Cardiologists were more than twice as likely to be paid by industry as family practitioners were, perhaps because they are recognized as the ones who set standards for prescribing widely used heart drugs, the authors suggested.
Where the physician practiced also made a difference, they found. Group practice doctors were six times as likely to get samples, three times as likely to receive gifts, and almost four times as likely to receive payments for professional services such as consulting than doctors in hospitals, clinics or staff-model HMOS. Male doctors and those with fewer Medicaid or uninsured patients also were more likely to receive payments.
"Specialties, organizations and practice leaders with an interest in reporting and managing physician-industry relationships may need to develop guidelines and recommendations that are specific to the context of each specialty and setting," the authors wrote.
Monday, April 23, 2007
Possible bipolar disorder genes found, scientist reports
By Carey Goldberg, Globe Staff
The data are so fresh and preliminary that researchers have not submitted a paper to a scientific journal yet. But Pamela Sklar, a geneticist at the Broad Institute and Massachusetts General Hospital, said yesterday that new genome scans have identified a crop of previously unsuspected genes that -– at first glance, at least -– may be connected to bipolar disorder.
Sklar spoke to the Boston Mental Health Research Symposium at the Boston Harbor Hotel, an event sponsored by NARSAD -– The Mental Health Research Association, a major funder of research on mental illness. The results are far from definitive, she said, and need to be replicated.
Sklar and others are taking advantage of rapid advances in gene-scanning technology to try to find the elusive genes for bipolar disorder –- which is believed to affect about 1 percent of the population -– as well as schizophrenia and other mental illnesses.
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Journal decries Supreme Court abortion ruling
By Carey Goldberg, Globe Staff
The New England Journal of Medicine this afternoon published online two commentaries and an editorial critical of the US Supreme Court's decision last week upholding the federal ban on the abortion procedure that opponents call "partial-birth abortion."
"With this decision the Supreme Court has sanctioned the intrusion of legislation into the day-to-day practice of medicine," writes Dr. Jeffrey M. Drazen, the Boston-based journal's editor-in-chief. Physicians are open to oversight and discussion of delicate matters, he says, but those discussions should occur "among informed and knowledgable people who are acting in the best interests of a specific patient."
Dr. Michael F. Greene, director of obstetrics at Massachusetts General Hospital, writes in another piece that the Supreme Court’s decision to uphold the ban "creates an intimidating environment" around second-trimester abortions. The result may be that doctors will feel too scared of prosecution to perform such abortions, even if the mother’s life is in jeopardy, he writes.
"Both health care providers and patients should be alarmed by the current degree of intrusion by our government into the practice of medicine," Greene writes.
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Wednesday, April 18, 2007
Redstone donates $35 million to Mass. General burn unit and ER
By Liz Kowalczyk, Globe Staff
Massachusetts General Hospital has received a $35 million donation for its burn unit and emergency department from media mogul Sumner Redstone, the largest single gift in the hospital's history.
Redstone, who nearly died in a 1979 Boston hotel fire and was treated for third-degree burns at Mass. General, has a long history with the hospital and has made previous donations to the burn unit. Of the current gift, $20 million will go toward research in burn and trauma care and a renovation of the unit.
The hospital will use the remaining $15 million to improve access in the emergency department, which will be re-named The Sumner M. Redstone Emergency Department. Mass. General president Dr. Peter Slavin said that since many burn patients are stabilized in the emergency room, Redstone saw helping that department as a natural extension of his relationship with the burn unit.
The emergency department is struggling to care for a growing number of patients, many of whom experience long waits for care or for hospital beds. The donation will pay for various stages of expansion of the ER, including four new triage rooms that will allow doctors to evaluate patients immediately when they arrive and begin tests sooner.
The hospital also plans a significant expansion of the ER as part of a multi-million new building that it plans to complete in 2011. That renovation will add another three triage rooms, a pediatric waiting area, and increase the number of patient bays from 44 to 60, said Dr. Alasdair Conn, chief of emergency services.
"Advancements in research and medical science are creating a better world and a higher quality of life for all of us. Like many, I have personally benefited from these advancements," Redstone said in a statement.
Wire services contributed to this story.
Monday, April 16, 2007
New genetic risk factors for Crohn's disease identified
Researchers from Massachusetts General Hospital and the Broad Institute of Harvard and MIT are part of a team that has discovered new genetic risk factors for Crohn's disease.
Reporting in the online Nature Genetics, they identify new genes that are involved in the immune system's response to bacteria. Crohn's disease, which affects about half a million Americans, is a chronic inflammatory bowel disease.
The authors include John D. Rioux, who has moved from the Broad to the Universite de Montreal, Ramnik J. Xavier, Alan Huett and Petric Kuballa of MGH, Todd Green of the Broad, and Mark J. Daly of the Broad and MGH.
Monday, April 9, 2007
MGH group to study genes and heart attacks
Researchers at Massachusetts General Hospital have won a three-year, $4.2 million grant from the National Heart, Lung and Blood Institute to study genes that may put people at risk for heart attacks, the hospital said.
Dr. David Altshuler, also a founding member of the Broad Institute of Harvard and MIT, and Dr. Sek Katherisan will look at gene variations in 1,500 people who had heart attacks at an early age and 1,500 who did not. They will use data from a study started in 1998 at eight sites, including Mass. General, that make up the Myocardial Infarction Genetics Consortium.
In men under 50 and women under 60, genes may play a greater role in heart attacks, they said. Heart attacks cluster in certain families, regardless of traditional risk factors, but this inherited risk is not explained by gene variants already known to contribute to disease.
Monday, April 2, 2007
Online autism registry seeks to connect families and researchers
Sixty families in Massachusetts were among 750 who tested a pilot version of the Interactive Autism Network, a website designed to accelerate research by connecting families with scientists who study the disorder. The site goes live today.
Julie Riley of Whitman, whose 7-year-old son is autistic, was among the testers during the pilot phase. She urged other parents to join the new network, both to learn from one another's experiences and to find answers for a future in which trial and error aren't the only way to discover what works.
"The more parents we get to participate, the more results we can get," she said in an interview. "I think it's a way to get closer to a cure."
The goal is to have families enter information about their children into a secure database that could be explored by researchers. The site is also designed to help researchers recruit participants for studies that have been approved by their institutional review boards.
There will be a forum for parents as well as information reviewed by doctors for scientific validity, founders Dr. Paul Law and Dr. Kiely Law of the Kennedy Krieger Institute in Baltimore said in an interview. They have a 13-year-old son with autism.
Dr. Margaret Bauman, associate professor of neurology at Harvard and head of the LADDERS program for developmental disorders at Massachusetts General Hospital, was on a committee that worked on the site.
"The hope is this mechanism will match families with researchers and vice versa," she said. "Parents who have been in the world of autism for a couple of years are asking questions."
The IAN project is supported by a $6.5 million grant from the non-profit Autism Speaks.
Monday, March 26, 2007
Aspirin linked to lower risk of death in women, but study authors urge caution
Women who regularly took low doses of aspirin had a lower risk of death from all causes, but particularly heart disease and cancer, Harvard researchers report in today's Archives of Internal Medicine.
But it's still too soon to recommend aspirin for the general prevention of disease, the lead author said.
"Women should not take this study, or any study, thus far as a license to take aspirin without any supervision," Dr. Andrew T. Chan of Massachusetts General Hospital said in an interview. "Women need to discuss with their physicians whether it makes sense for them, get a sense of what their risk is for cancer or cardiovascular disease, and strategize with them how to prevent the risk of disease through other means."
Chan and his colleagues looked at 24 years of data from nearly 80,000 healthy women enrolled in the observational Nurses Health Study. Women who said they used aspirin had a 38 percent lower risk of dying from cardiovascular disease and a 12 percent lower risk of dying from cancer. Their overall risk of death was 25 percent lower than women who never took aspirin regularly.
The reduction in cardiovascular disease became apparent after five years and in cancer after 10 years.
The findings conflict with another large study of women and aspirin use called the Women's Health Study. That clinical trial, in which 40,000 women randomly received aspirin or placebo, concluded that aspirin had no effect on mortality, from cardiovascular disease or other causes.
In an editorial, Dr. John A. Baron of Dartmouth Medical School says the nurses study may not have been able to account for the differences between aspirin users and non-users, suggesting women who decide to take aspirin may have better health in the first place.
"These new findings by Chan et al cannot overcome the accumulated evidence that aspirin is not particularly effective for the primary prevention of death from cardiovascular disease in women," he wrote.
Chan responded that he and his co-authors were able to account for health differences among the women in the nurses study because they had detailed information on risk factors. They found that women who were older and had more risk factors for cardiovascular disease were the ones who benefited the most from low to moderate aspirin use, defined as 1 to 14 325-milligram tablets per week.
Higher doses of aspirin have been linked in many studies to gastrointestinal bleeding, the authors noted.
The authors say their study confirms the importance of common mechanisms in both cancer and heart disease, such as inflammation. Aspirin is an anti-inflammatory and inflammation has been implicated in the formation of plaque that blocks arteries as well as in the transformation of normal tissue into cancer.
Proven ways to lower risk of disease are eating a healthy diet, maintaining a good body weight and exercising, Chan said.
"We know those modifications don't have risks," he said.
Thursday, March 22, 2007
Local doctors comment on the return of Elizabeth Edwards' cancer
By Scott Allen, Globe Staff
Edwards admitted she had not undergone a routine mammogram for years before she discovered a lump that "felt nearly as big as a plum" while showering during the last days of John Edwards' vice presidential campaign in 2004.
Because doctors won't be attempting to eradicate all cancer cells this time, Moy said, Edwards may receive less intensive chemotherapy, localized radiation or various hormone treatments that have relatively few side effects.
Boston oncologist picked to lead Fox Chase
Dr. Michael V. Seiden, a leading cancer clinician and researcher, is leaving Boston to become president and CEO of Fox Chase Cancer Center in Philadelphia, the center announced today.
Seiden, 48, is head of the gynecological cancer program at the Dana-Farber/Harvard Cancer Center and chief of clinical research in cancer medicine at Massachusetts General Hospital. An associate professor of medicine at Harvard, his research focuses on ovarian cancer tumor biology. He is the physician coordinator of the cancer stem cell project at the Dana-Farber/Harvard Cancer Center.
On June 1 he will succeed Dr. Robert C. Young, 67, who is retiring from Fox Chase, which treats about 6,500 new patients a year and employs about 2,500 people.
Seiden is a graduate of Oberlin College and earned his M.D. and Ph.D. at Washington University in St. Louis. He completed his internship and residency at Mass. General, was a fellow in medicine at Harvard, did a three-year clinical fellowship in medical oncology at Dana-Farber Cancer Institute and was a postdoctoral fellow in molecular pathology at Brigham and Women's Hospital.
Tuesday, March 20, 2007
Tanzi wins Alzheimer's Association honor
Rudy Tanzi, director of the Genetics and Aging Unit at Massachusetts General Hospital, has won the Alzheimer’s Association's 2007 Ronald and Nancy Reagan Research Institute Award.
Tanzi, who isolated the first Alzheimer's disease gene in 1987 and collaborated on the identification of two more in 1995, launched the Alzheimer's Genome Project late last year to identify all the genes involved in the disease.
CIMIT gets grant to bring managers and scientists together
CIMIT, or the Center for Integration of Medicine and Innovative Technology, has received a $367,080 grant from Boston Scientific co-founder and director John E. Abele and his family's Argosy Foundation.
The money will be used to help its members collaborate through the CIMIT Forum, the organization said. CIMIT is a consortium of teaching hospitals and engineering schools set up by Massachusetts General Hospital to speed the development of promising therapies.
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Monday, March 19, 2007
New trend in organ donation raises questions
A new approach to organ donation is saving the lives of more waiting patients but, some say, it risks sacrificing the interests of the donors, according to a story in Sunday's Washington Post.
In "donation after cardiac death," surgeons remove organs within minutes after the heart stops beating and doctors declare a patient dead, the story says. Most organs are removed only after doctors have declared a patient brain dead.
Two Boston doctors and a woman whose son became a donor at Massachusetts General Hospital voice their opinions.
"People are dying on the waiting list," said Francis L. Delmonico, a transplant surgeon at Harvard Medical School, speaking on behalf of the United Network for Organ Sharing. More than 95,000 Americans are waiting for organs. "This is vital as an untapped source of organ donors."
Nancy Erhard's 25-year-old son, Bo, became a DCD donor at Mass. General in November 2005 after a burst artery caused devastating brain damage, the story said.
"There was no hope. He would never regain conscious thought," Erhard said. "This gave his life so much more meaning in the end because he was able to help so many others."
Michael A. Grodin, director of Boston University's Bioethics and Human Rights Program, said the practice is troubling.
"The image this creates is people hovering over the body trying to get organs any way they can," he said. "There's a kind of macabre flavor to it."
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In case you missed it: surprise check faults MGH
Inspectors found numerous quality of care problems at Massachusetts General Hospital during a surprise inspection late last year, noting concerns about medication safety, inconsistent handwashing by caregivers, and incomplete medical records, Liz Kowalczyk reported in Saturday's Globe.
Thursday, March 15, 2007
In Science: HIV evolution is unpredictable
In tomorrow's issue of the journal Science, four researchers from Massachusetts General Hospital -- Nicole Frahm, Toshiyuki Miura, Christian Braner and Bruce Walker -- are among the authors of a paper that says HIV evolution appears to be less predictable than previously thought. They discuss specific ways the rapidly evolving virus changes that may have implications for vaccine design.
Tuesday, March 13, 2007
Breast cancer drug wins FDA approval
By Scott Allen, Globe Staff
Federal regulators today approved a new treatment for breast cancer that oncologists believe could be the second coming of Herceptin, one of the most successful anti-cancer drugs of the last decade.
The Food and Drug Administratrion is expected to approve Tykerb, also called lapatinib, for women with advanced cancer that can no longer be controlled by Herceptin, but major studies are already underway to find out if Tykerb should also be given to millions of women who are in the early stages of cancer.
Goss said Tykerb might be even more effective than Herceptin, which is credited with extending the life expectancy by more than 1.5 years for women who suffer HER-2 positive breast cancer. Tykerb, he said, appears to shut down more molecular pathways that lead to cancer than Herceptin partly because Tykerb molecules are small enough to get inside cancer cells. As a result, he said Tykerb could be stronger than Herceptin and work in some women other than the 20 to 30 percent who have the HER2-positive form of the disease.
"If I can equate it to lighting a building and your task is to turn all the lights off, you can go room by room and turn them off, or if you're lucky, you discover a circuit breaker that can shut down whole floors," said Goss. Tykerb "might be that circuit breaker."
Goss said it's premature for doctors to prescribe Tykerb for early stage breast cancer unless women can't take Herceptin for some reason, such as side effects. In the long run, he said doctors will likely need both, though women may like Tykerb better because, unlike Herceptin, it's a pill rather than an injection.
Monday, March 12, 2007
Looking for compassionate caregivers
Do you know a doctor, nurse or other caregiver who displays extraordinary compassion? The Kenneth B. Schwartz Center is looking for nominations for its 9th annual Compassionate Caregiver of the Year Award. The winner will receive $5,000 and four finalists will receive $1,000 each.
The award honors Kenneth B. Schwartz, the Center’s founder and a health care attorney who died in 1995 after battling lung cancer. Nominations are due April 16.
The Schwartz Center is a non-profit organization housed at Massachusetts General Hospital promoting ways to improve relationships between caregivers and patients.
Wednesday, March 7, 2007
Soliciting organ donations undermines fairness of waiting list, surgeon writes
Soliciting organ donations, whether on billboards or on the Internet, raises ethical questions and threatens the fairness of how organs are allocated, Dr. Douglas W. Hanto writes in tomorrow's New England Journal of Medicine.
Organs from deceased donors go to the people at the top of the waiting list maintained by the United Network for Organ Sharing, which is regulated by the federal government. The only exception is made for family members of deceased donors.
But when it comes to living donors who may come forward to give a kidney or part of a liver, there are no policies regulating directed donations, writes Hanto, chief of transplantation at Beth Israel Deaconess Medical Center and professor of surgery at Harvard Medical School.
"We don't have enough organs for everybody," he said in an interview. "I would like to see the system change so those donations are directed to the top of the waiting lists, after family, friends and pre-existing relationships."
Most organs from living donors go to friends or family members, according to UNOS figures, but there are increasing numbers of prospective donors with no relationship to the potential recipient. Between 1996 and 2006, the percentage of living donors without close ties rose from 6.5 percent to 23 percent.
Websites such as Canton-based matchingdonors.com were created to connect people who need transplants with live organ donors. Phone messages seeking comment today were not returned, but on its website, matchingdonors.com says "there are thousands of wonderful, altruistic and compassionate people willing to help a fellow human being. It is our belief that many of the potential donors would have never considered live organ donation if it wasn’t for the increased awareness due to our site."
Hanto urges development of rules to guard against unfair allocation of organs from living donors that will protect donors and recipients alike. He points to a study in Minnesota of altruistic donors, whose desire to donate was unaffected by knowing who would receive their gift compared with their organ going to the person at the top of a waiting list.
Hanto also cites concerns that organs will go to people with more advantages (as shown by their access to the Internet), that the potential for illegal payment is greater without previous close ties, and that recipients might be vulnerable to later demands from donors.
Dr. Francis L. Delmonico, a transplant surgeon at Massachusetts General Hospital, medical director of the New England Organ Bank and past president of UNOS, agrees that solicitation of living donors raises concerns, but he thinks that there is no legal basis to regulate how people find or identify a donor, through matchingdonors.com or other groups.
"It is not for us to tell people how they can make relationships," he said in an interview. "But it is for UNOS and for the transplant centers to exercise some caution."
Transplant centers perform a psychosocial as well as a medical evaluation of any potential donor.
"I would say this has to be done in a more heightened way," Delmonico said about screening. "The risks that are associated with donors that come along under the circumstances of solicitation are greater in having misunderstanding by the donor and misunderstanding as to what is being derived for the recipient."
Hanto does endorse the New England Kidney Exchange, an effort to pair living donations in cases where one potential donor might not be a match for the loved one they hope to help, but that organ can be exchanged for a match with another pair in the same situation who can provide a compatible organ.
"I think that's a terrific idea," he said. "It's not going to solve the whole problem, but it's a great solution."
Thursday, March 1, 2007
Snub of the universe? Postdocs pick elsewhere
Not a single institution on either side of the Charles cracked the Top 15 places to work in a survey of postdoctoral life scientists, the March issue of The Scientist magazine says.
Training and experience matter the most to these researchers, who have finished their Ph.D.s but don't have faculty positions, the survey reports. They ranked access to books and journals next, followed by affordable medical insurance and then equipment and supplies for research.
The closest Boston or Cambridge came was Beth Israel Deaconess Medical Center's 28th-place finish, shooting up from 97th last year.
Harvard Medical School, Brigham and Women's Hospital, Woods Hole Oceanographic Institute and Dana-Farber Cancer Institute also made the top 40. MIT dropped out of the top 40, placing 53rd.
M.D. Anderson Cancer Center in Houston topped the list, zooming up from 29th last year. The J. Gladstone Institutes in San Francisco slid to second place from first. The U.S. Environmental Protection Agency in Research Triangle Park, N.C., stayed in third.
Here's how postdocs ranked area institutions, with the 2006 ranking in parentheses:
Beth Israel Deaconess: 28 (97)
A total of 96 institutions in North America were ranked this year. Research centers with too few responses were not listed, including some in the Boston area.
For its "Best Places to Work 2007: Postdocs," the magazine polled its readers about conditions in their research facilities. The Web-based questionnaire pulled in 2,555 usable responses from people who identified themselves as non-tenured scientists working in academia or other non-commercial research organizations.
So, postdocs, White Coat Notes wonders what you think about where you work. Send us your thoughts at firstname.lastname@example.org.
Wednesday, February 28, 2007
Weighing the risks and benefits of Caesareans
Caesarean deliveries continue to climb, two Massachusetts General Hospital obstetricians write in a perspective piece appearing in tomorrow's New England Journal of Medicine. The rising number suggests that doctors need to do more to educate their patients about the trade-offs and to ensure that their choices fit their own philosophy, plans, and risk tolerance. Clinical trials should be launched to produce the data needed for counseling patients, Dr. Jeffrey L. Ecker and Dr. Fredric D. Frigoletto Jr. write.
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Friday, February 23, 2007
Mass. General president swings back
By Liz Kowalczyk, Globe Staff
Dr. Peter Slavin, president of Massachusetts General Hospital, jumped into the fray yesterday over the blog started by his competitor, Paul Levy, chief executive of Beth Israel Deaconess Medical Center.
Levy has posted on his website month-by-month hospital-acquired infection rates for patients at his hospital, and challenged other hospitals to publicize their rates as well, according to a story in today's Globe.
Slavin confirmed that Mass. General will not publicize its infection rates, at least not until the state develops a standardized approach to measurement that has been embraced by the medical community. But he made it clear his hospital has nothing to hide: "Our internal data shows our numbers are lower than Beth Israel's," he said.
"There are at least two ways to compete in health care, provide great care, do great research and excel at teaching -- that's the way we choose to do it," Slavin said. "The other way is to criticize one's competitors. That's not the method we choose to employ."
Wednesday, February 21, 2007
Project seeks to limit ties between doctors, drug companies
A new campaign called The Prescription Project seeks to end conflicts of interest that may arise from pharmaceutical company marketing aimed at physicians. It calls for academic medical centers to tighten their policies governing ties with industry.
"We are looking to see that payers, consumers and physicians work together to promote evidence-based medicine and to counter the bias of drug marketing," said Robert Restuccia, the project's Boston-based executive director.
The Prescription Project points to Stanford University Medical School, University of Pennsylvania Health System and Yale University School of Medicine as leaders. While their models vary, the institutions restrict gifts to doctors, drug samples and visits by industry sales representatives.
Boston hospitals surveyed by the Globe during the past week say they require drug company employees and other vendors to register with them before visiting, but other policies vary.
Tufts-New England Medical Center does not allow pharmaceutical sales representatives in clinical areas. Caritas St. Elizabeth's Medical Center says its doctors cannot give patients free samples of medications, but Partners' hospitals, Brigham and Women's and Massachusetts General, do let doctors give free samples to patients at certain approved sites, such as a practice serving a significant number of uninsured patients unable to pay on their own.
Beth Israel Deaconess Medical Center and St. Elizabeth's prohibit on-site meals paid for by drug companies and restrict gifts to under $100. Partners' hospitals have a similar cap on what doctors can accept. Gifts may include nominal-value items related to education or patient care, the Partners' rules say.
A speaker or panelist at a professional meeting may accept payment for expenses if the meeting's purpose is "promoting objective scientific and educational activities," the Beth Israel Deaconess policy states.
"We take this issue very seriously and continue to update our policies," said St. Elizabeth's spokeswomen Melanie Franco. "We will look at what the Prescription Project is saying."
The Prescription Project, funded by $6 million from the Pew Charitable Trusts, is a joint effort of Community Catalyst in Boston and the Institute on Medicine as a Profession at Columbia University. Its impetus was a January 2006 article in the Journal of the American Medical Association that said the $12 billion spent annually on drug marketing influences how doctors prescribe medications, whether they receive free lunches, free samples or free trips from companies.
Monday, February 19, 2007
We're 'wired to connect,' MGH research shows
We know what it feels like to sense a connection with another person. It's called empathy.
But researchers from Massachusetts General Hospital wanted to measure biologically the experience we have when we feel understood and connected with somebody. They studied interactions between patients and their psychotherapists, whose job is to be empathetic.
Using skin sensors that measure arousal and observers' reactions to videotaped therapy sessions, they found that the more therapists and patients felt the same, the more connected they seemed to be and positive about the relationship. The study appears in the February Journal of Nervous and Mental Diseases.
"When we feel like we are really connected, we literally are in tune with others," said Dr. Carl D. Marci, director of social neuroscience at Mass. General. "This supports brain imaging data that shows humans are literally 'wired to connect' emotionally."
The 20 patient-therapist sessions suggested that shared positive emotions and shared physiological responses create an empathetic connection.
How therapists engage with their patients can play a huge role in the outcome of therapy, Marci said, so these findings can help therapists do a better job.
One other factor was important: Patients and therapists seemed more in tune when the therapist was listening.
"It's very hard to be empathetic when you are talking," he said. "Talking is engaging an altogether different part of the brain to think about what you are saying. You sort of shut down or dampen this emotional response we have."
Thursday, February 8, 2007
Report: Mass. General sees barriers to Florida site
Massachusetts General Hospital has no immediate plans to open a health-care facility in northern Palm Beach County, Florida, but the institution is still considering the idea, President Peter Slavin said yesterday, according to the Palm Beach Post.
Massachusetts General officials, in Palm Beach this week for their annual fund-raising trip, say several factors stand in their way of opening a satellite facility in Jupiter, including the large number of uninsured patients, the popularity of concierge practices and concern that it could not offer the same array and quality of services away from its Boston base.
"We're still interested in the opportunity," Slavin said Tuesday before a late afternoon health symposium and cocktails with donors at the Four Seasons Palm Beach. "But we have no specific plans yet."
Any plans would include Brigham and Women's Hospital, also owned by Partners HealthCare, the Post story said.
Tuesday, February 6, 2007
Boston stroke expertise exported to Seattle
A Seattle hospital has hired Dr. Lee Schwamm, director of acute stroke services, and his colleagues at Massachusetts General Hospital to help them build a remote stroke service for community hospitals in Washington state.
Many stroke patients do not get the best treatment available because time is of the essence and few community hospitals are staffed at all hours by brain doctors with the expertise to make treatment decisions. To address this problem, Massachusetts is among the first states where neurologists have begun to recommend treatment for stroke patients without seeing them in person. Using telemedicine, they read brain scans over the Internet at all hours and consult over live video hookups.
Fourteen community hospitals in Massachusetts have signed contracts with Mass. General's "telestroke" service, and Swedish Medical Center in Seattle is the first to hire the Mass. General team as consultants.
-- Liz Kowalczyk
Tuesday, January 30, 2007
More than half Boston hospital workers got flu shots
More Boston hospital workers may be getting flu shots this season than the national average, but beyond that it’s hard to figure out how they measure up.
Public health officials have been pushing for virtually all hospital workers to get flu shots because they can easily be exposed and infect vulnerable patients. But each of six hospitals that answered a White Coat Notes query today counts health care workers involved in direct patient care in its own way. And they don’t necessarily know who might have gotten a flu shot outside their hospitals' programs.
Here are the results:
Boston Medical Center: 71 percent
"The national average is 38 percent," said Dr. Robert Goldszer, associate chief medical officer at Brigham and Women’s. "We feel we’re doing better than average, but we know we don’t have an accurate rate."
Beth Israel has a broad definition of who comes into direct contact with patients. It’s not just the people who have day-to-day hands-on contact, but it also includes people who see patients face-to-face, such as ward secretaries, people who sit at the front desk in clinics, and workers who clean floors in patients’ rooms, said Dr. Sharon Wright, director of the infection control and hospital epidemiology program.
Beth Israel tries to track who gets a flu shot elsewhere, she said, asking employees to use an internal web site to state explicitly why they are declining to get a flu shot.
The Joint Commission on Accreditation of Healthcare Organizations requires hospitals to at least offer flu shots. The Infectious Diseases Society of America recommends that hospitals and other health care facilities mandate flu shots for employees, except for religious or medical reasons.
"JCAHO told us to immunize 100 percent of health care workers who don’t have a contraindication," Beth Israel's Wright said. "We’re trying to get to that 100 percent in three to five years. The goal this year was 60 percent and we did it."
"Obviously we think everybody should get vaccinated against the flu, but it’s especially important for health care workers," he said.
Too young to face cancer
Fighting cancer under 40 raises special challenges, the first of which is believing it can happen to you. Dr. Karen Albritton of the Dana-Farber Cancer Institute, Dr. Bruce A. Chabner of Massachusetts General Hospital Cancer Center and Dr. Nadine Tung of Beth Israel Deaconess Medical Center comment in a New York Times story.